Provider Demographics
NPI:1902299720
Name:COMELLA, ANTHONY T (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
Last Name:COMELLA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:T
Other - Last Name:COMELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:366 EUCLID AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3221
Mailing Address - Country:US
Mailing Address - Phone:415-699-5099
Mailing Address - Fax:
Practice Address - Street 1:290 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4882
Practice Address - Country:US
Practice Address - Phone:415-699-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 42400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist